[Perforated peptic ulcer in patients with cancer: prediction of postoperative morbidity and mortality]. / Probodnaya yazva u patsientov s onkologicheskimi zabolevaniyami: prognozirovanie posleoperatsionnykh oslozhnenii i letal'nogo iskhoda.

OBJECTIVE: To analyze treatment outcomes and approaches to predicting the postoperative morbidity and mortality in patients with perforated ulcers and cancer. MATERIAL AND METHODS: A non-randomized trial included 194 patients. The first group enrolled 45 (23%) patients with perforated ulcers and concomitant cancer who underwent at the oncology center; the second group included 149 (77%) patients with perforated ulcers and no cancer who underwent surgery in general surgical hospitals. Organ-sparing procedures prevailed (40 (88.9%) and 138 (92.6%) cases, respectively). Resections were performed in 5 (11.1%) and 11 (7.4%) patients respectively. Analyzing the factors affecting treatment outcomes, we studied crude (COR) and adjusted (AOR) odds ratios. ROC-analysis was used to assess diagnostic significance of the models for prognosis of morbidity and mortality. RESULTS: Length of hospital-stay was 10 (range 9-14) and 8 (range 7-9) days respectively. Postoperative complications (Clavien-Dindo grading system) occurred in 18 (40%) in 37 (24.8%) patients, respectively. According to multivariate analysis, predictors of complications in patients of the first group were treatment with NSAIDs/glucocorticoids and Charlson-Deyo index >3. Sensitivity of this model was 82.4%, specificity - 75.0%. Postoperative mortality was 15.6% (n=7) and 7.4% (n=11) respectively. According to multivariate analysis, predictors of mortality were age over 65 years and more than 5 chemotherapeutic courses. Sensitivity of the model was 85.7%, specificity - 97.4%. CONCLUSION: The stratified approach makes it possible to improve prediction of postoperative morbidity and mortality in patients with perforated ulcers.

[Laparoscopic subtotal distal gastrectomy for distal gastric cancer]. / Opyt vypolneniya laparoskopicheskoi subtotal'noi distal'noi rezektsii v lechenii bol'nykh rakom antral'nogo otdela zheludka.

OBJECTIVE: To analyze the primary results of laparoscopic distal gastrectomy in patients with distal gastric cancer. MATERIAL AND METHODS: There were 21 laparoscopic distal gastrectomies in patients with distal gastric cancer. Mean age of patients was 63.7±6.3 years. According to TNM staging system, cancer stage 1 was detected in 90% of patients (n=19), stage 2a - in 10% (n=2) of patients. RESULTS: Time of distal gastrectomy was 190.4±51.6 min, blood loss - 90.3±51.2 ml. The number of excised lymph nodes was 21.2±5.1. We were able to achieve R0 resection edge in all patients. Length of hospital-stay was 7.6±2.3 days, incidence of postoperative complications - 23.8%. Complications Clavien-Dindo grade IIIb-V were observed in 9.5% of patients (n=2). Overall postoperative mortality was 4.7% (n=1). No progression of the underlying disease has been revealed in any patient throughout the follow-up period (since May 2018). To date, the maximum median follow-up is 25 months of overall and disease-free survival. CONCLUSION: Laparoscopic subtotal distal resection is an appropriate intervention ensuring R0 resection edge in most cases.

[Laparoscopic subtotal distal resection for distal gastric cancer]. / Opyt vypolneniya laparoskopicheskoi subtotal'noi distal'noi rezektsii v lechenii bol'nykh rakom antral'nogo otdela zheludka.

OBJECTIVE: To analyze the primary experience of laparoscopic distal gastrectomy in patients with distal gastric cancer. MATERIAL AND METHODS: There were 21 laparoscopic distal gastrectomies in patients with antrum malignancies. Mean age of patients was 63.7±6.3 years. According to TNM staging system, cancer stage I was detected in 90% of patients (n=19), stage IIa - in 10% (n=2) of patients. RESULTS: Duration of distal gastrectomy was 190.4±51.6 minutes, blood loss - 90.3±51.2 ml. The number of harvested lymph nodes was 21.2±5.1. We were able to reach R0 resection edge in all patients. Length of hospital-stay was 7.6±2.3 days, incidence of postoperative complications - 23.8%. Complications Clavien-Dindo grade IIIb-V were observed in 9.5% of patients (n=2). Overall postoperative mortality was 4.7% (n=1). No progression of the underlying disease has been revealed in any patient throughout the follow-up period (since May 2018). To date, the maximum median follow-up is 25 months of overall and disease-free survival. CONCLUSION: Laparoscopic subtotal distal resection is appropriate intervention ensuring R0 resection edge in most cases.

[Influence of the incidence of ulcerative gastroduodenal bleeding on the effectiveness of treatment. Statistical surveillance]. / Vliyanie zabolevaemosti yazvennym gastroduodenal'nym krovotecheniem na effektivnost' lecheniya. Statisticheskoe nablyudenie.

OBJECTIVE: To study and to justify statistically the influence of the incidence of ulcerative gastroduodenal bleeding on the results of treatment. MATERIAL AND METHODS: The results of treatment of 56.233 patients with ulcerative gastroduodenal bleeding in the Central Federal district have been analyzed throughout a 5-year follow-up period. Statistical analysis was performed in Microsoft Excel 2007 and Review Manager 5.3. RESULTS: Overall in-hospital mortality (r=0.871) and surgical activity (r=0.725) depend on the number of patients with ulcerative bleeding. Active surgical approach was followed by overall in-hospital mortality 6.9%, moderate surgical approach - 5.3% (OR 1.3%, 95% CI 1.18-1.4, p<0.05). CONCLUSION: The correlations between the number of patients with ulcerative bleeding and surgical activity, overall in-hospital and postoperative mortality were identified in a large sample.

[Distal subtotal gastrectomy and gastreectomy in surgical treatment of patients with gastric cancer: a systematic review and meta-analysis]. / Sravnitel'naya otsenka subtotal'noi distal'noi rezektsii i gastrektomii v khirurgicheskom lechenie bol'nykh rakom zheludka.

OBJECTIVE: To analyze the randomized controlled trials (RCTs) devoted to distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer. MATERIAL AND METHODS: RCTs were searched in the electronic library, the Cochrane Community database, and PubMed database. A systematic review and meta-analysis were carried out in accordance with the recommendations of the Cochrane Community experts (Higgins et al. 2019). Mathematical calculations of a meta-analysis were made using RevMan 5.3 software package. Statistical criteria were calculated for relative risk (RR), hazard ratio (HR), 95% confidence interval (95% CI) and significance level (p). RESULTS: Seven primary RCTs were selected. A total number of 1463 surgical interventions with D2 lymphadenectomy were observed (805 patients underwent distal subtotal gastrectomy, 658 - gastrectomy). Postoperative mortality is significantly higher (6.5% and 2.6%) after gastrectomy compared to subtotal distal gastrectomy (RR 2.2, 95% CI 1.34-3.64, I2 0%, fixed effect model). Postoperative complications are also significantly more common (28% and 14%) after gastrectomy (RR 1.72, 95% CI 1.16-2.55, I2 heterogeneity 49%, random effect model). Differences in overall five-year survival after gastrectomy and subtotal distal resection (51.6% and 60.8%) are insignificant (HR 0.74, 95% CI 0.45-1.22, I2 90%, random effect model, general reverse inversion). CONCLUSION: The choice of distal subtotal gastrectomy and gastrectomy with D2 lymphadenectomy in patients with distal gastric cancer is not regulated by evidence-based medicine. The boundaries of minimal surgical clearance from the tumor edge vary from 2.5 cm to 6 cm. An updated meta-analysis shows that postoperative mortality and morbidity are significantly higher after gastrectomy compared to distal subtotal gastrectomy while overall 5-year survival is similar.

[General methodology of meta-analysis and data interpretation in surgery]. / Obshchaia metodologiia provedeniia i interpretatsii rezul'tatov meta-analiza v khirurgii.

Meta-analysis is a leading methodology used in systematic secondary researches. Review Manager software is the main tool used by leading world expert groups for meta-analysis. The authors analyzed the features of meta-analyzes evaluating the results of surgeries. It is shown that the majority of baseline clinical parameters correspond to normal distribution (in accordance with central limit theorem) considering the fact that surgical outcomes depend on various and often unpredictable factors. Moreover, multiple heterogeneous variables are compared in the meta-analysis due to the differences in diagnostic scales and methods of evaluating the results in primary researches. Therefore, both absolute and standardized measurements are required for these purposes. The authors describe the features of meta-analysis for dichotomous, continuous and skewed data, as well as for ordinal outcomes, time-to-event, counts and ratios. These data are useful to interpret numerical values, objectively evaluate the majority of surgical outcomes and predict the effectiveness of interventions.

[Perforated duodenal ulcer in high risk patients]. / Operatsiia ushivaniia perforativnoi iazvy dvenadtsatiperstnoi kishki u bol'nykh gruppy riska.

AIM: To improve the outcomes in patients with perforated duodenal ulcers. MATERIAL AND METHODS: Cohort study included 456 patients with perforated duodenal ulcer. High risk of mortality was determined in 9% of patients (n=40) considering Boey diagnostic criteria (1982, 1987). There were 19 women and 21 men aged 59±2.8 years. RESULTS: Perforated duodenal ulcer was followed by overall mortality near 3.8%. In high risk group this value was 17.5% (7 out of 40 patients) while expected mortality was 45.5-100% in these patients in view of Boey criteria. The main causes of death were multiple organ failure, pulmonary embolism and acute myocardial infarction. CONCLUSION: Minimally invasive surgery including step-by-step procedures (mini-laparotomy, laparoscopy and navigation) are the key to improve the outcomes in patients with perforated duodenal ulcer.